Sunday, 8 January 2017

The first type of treatment method is by taking medications. And so what are the medications available for OCD patients? Drugs used for patients suffering from depression are also used for patients with OCD, but in a higher dosage. Selective Serotonin reuptake inhibitors (SSRIs) increase extracellular serotonin levels by inhibiting reuptake, allowing more serotonin to cross the synapse. Selective serotonin reuptake inhibitor (SSRI) drugs such as fluvoxamine, fluoxetine and sertraline are available for OCD patients in Singapore. These drugs have different effects on different people; some may develop side effects but some others might find it completely useful. Psychiatrists may give the patient other drugs, or combine a few of these drugs to a patient who is resistant to a drug (Nobel, n.d.).

The second type of treatment is psychotherapy (NIHM, 2016). Psychotherapy include counselling sessions with a psychiatrist. The only form of psychotherapy that has been proven to be effective in treating this disorder is exposure and response prevention (ERP) (Stanford, 2016). Psychotherapy is an effective way to treat OCD in both adults and children. Around 50% of patients suffering from OCD that undergo this form of treatment benefit from it without the consumption of medications. It is also proven to be effective for those who do not respond well to medication as a form of treatment. 20% to 30% of patients are resistant to this form of treatment. As for patients that underwent psychotherapy for 6 months to three or more years, 25% of them do not benefit much from it. (Stanford, 2016). Psychotherapy can be received at various mental health institutes that provide with a counsellor. Some patients also receive both types of treatment in combination either because just having either treatment is not enough for them or they want to recover at a faster pace.

Apart from having professional help, patients with OCD who are on the route to recovery can join peer support groups to share their experiences. This lets them know that they are not alone in this battle against OCD. Peer support groups such as Sunshinepath run by the Singapore Association of Mental Health (SAMH) allow patients to learn about how others cope with their illness. These groups allows patients to form a tightly-knitted bond with a group of friends which will allow them to gain exposure to social interactions again and they can learn how to integrate back into society once again.

As much as patients require the help of other people who share the same experiences, one of the most crucial players in getting the patients to recover are their family members. As such, groups such as the Caregivers Alliance provides training for caregivers to better understand how they can provide help and support to their family member suffering from OCD.

In Singapore, there is still a stigma around mental illnesses in general. The best way a person struggling with OCD or other mental illnesses could recover is to have support from their loved ones. Mental illnesses are not treated the same as physical illnesses. People need to be aware that mental illnesses do not define a person. With this awareness, people that are struggling with mental illnesses will seek professional help, without the fear of getting judged by the society.

As we covered in our previous posts, the reason why a person develops OCD is a combination of a few factors, one of which is genetics. How do genetics play a role in the development of OCD?

Experts have yet to find the particular gene that causes OCD. However, research indicates that OCD runs in families, which means that genetics is likely to play a role in the development of OCD. The chances among relatives having OCD is 5 times higher than among relatives that do not have OCD (WebMD, Inc., 2000). In a study led by Dr. Gerald Nestadt, involving 1,406 people with OCD, 1,000 close relatives of the patients with OCD and the general public, it was found that patients with OCD had a “significant association” on chromosome 9, which is near a gene called protein tyrosine phosphokinase (PTPRD) (Honor, 2014). This gene has been related learning and memory. This gene also has association to some attention deficit hyperactivity disorder (ADHD) cases. A few symptoms of ADHD are similar to those of OCD.

According to research based in the US, where DNA samples from patients with OCD were examined, results proved the possibility that OCD may be developed because of a rare combination of two mutations within the human serotonin transporter gene (hSERT) (UK, n.d.). This gene codes for the human serotonin transporter and also the transport protein used for the reuptake of serotonin from the synapse between two neurons. As we covered in the earlier posts, serotonin helps to regulate mood naturally.

The first mutation is associated with increased expression of the hSERT gene, therefore having more transport proteins on the membrane of the neuron. This causes an increase in reuptake of serotonin, decreasing the amount of serotonin that is available for communication. The second mutation has similar cellular effects. These two mutations combined causes a significantly lower levels of serotonin available for communication.

OCD is not something that can be cured easily overnight neither can it be cured if the patients themselves really want to as perceived by some. Those who have experienced abuse during their childhood or some trauma increases the chances of getting OCD (National Institute of Mental Health, 2016). OCD is a condition that may be contained through counselling and self help groups, which we will be covering in subsequent posts.

People with OCD suffer both mentally and physically. Mentally, they are constantly bombarded by recurring disturbing images that always leave them thinking things such as “Have I switched off the gas stove?” or “Have I locked the front door?” or “Are there still germs on my hands?” And because of that, it leads to them doing things like checking over and over whether the door is locked or whether the stove has been turned off or washing their hands repeatedly to make sure there is no more germs that can be residing on them. The cycle goes on repeatedly. And it stresses them out constantly. The risks of getting OCD can be increased by a person's environment. For example,having suffered from any mental or physical abuse during their childhood or other types of trauma.

The fight to deal with OCD is a constant battle. For no one chose to be born with OCD. As such, why are we always stigmatising those with OCD? Such social stigmatisation makes it harder for patients who have recovered or are still on the road to recovery to fit back into society. The social stigma is also something that prevents most people from seeking treatment, which can cause the worsening of their illness. Our views on people with OCD causes them to have to deal with a constant burden on their shoulders for they are unable to openly share about their issues and because of that, their recovery may be deterred or slowed down.

To most, it seems as though OCD only takes its toll on their victims. What most don’t realise is that it also affects the patients’ loved ones. There have been many extreme cases of OCD wrecking the lives’ of family members. One example would be how a patient, who also happened to be a hoarder, had habits of washing her hands 300 times and spending 5 hours on washing her hair 25 times a day. Her compulsive habits led to her mother who was suffering from arthritis to have to use public toilets to do the laundry and shower and sleep outside on the steps for 3 months where she got wet whenever it rained. It caused her mother’s ailment to worsen. Furthermore, her mother was later diagnosed with schizophrenia and after being diagnosed with a heart attack, she was sent to a nursing home (Tai, 2016). The patient regrets the fact that her illness caused her to neglect her mother. This shows how much of an ordeal some family members of severe OCD patients have to go through.

Experiencing OCD is not a simple task for both patients and their loved ones, especially if one is dealing with severe OCD and does not seek treatment. How can our society help those who are suffering to recover? Let’s discover more in the next posts to come.

A person with OCD goes through a vicious cycle of obsessive thoughts and compulsive behaviours. These obsessive thoughts are often involuntary, and it can occur in the form of images in their heads (HelpGuide.org, 2016). The compulsive behaviours are done to make the thoughts go away temporarily (HelpGuide.org, 2016). When they get obsessive thoughts, they start to feel anxious. In order to cope with the anxiety, these people act on their thoughts, causing them to behave compulsively. Their compulsive behaviour gives them temporary relief, but not for long.

The exact cause of OCD remains a mystery to scientists. However, scientists believe that a person develops this disorder because of a combination of factors. The factors include neurobiological, environment, cognitive, genetics, and behaviour (UK, n.d.).

We will be covering these factors one by one through our blog posts. In this blogpost, we will be covering the neurobiological factor.

The frontostriatal circuit in our brains are neural pathways which mainly consists of three areas in the brain, the prefrontal cortex, basal ganglia, and thalamus. The prefrontal cortex is in-charge of decision making, the basal ganglia filters information coming from the prefrontal cortex and it is involved in controlling repetitive behaviors. What researchers have found is that basal ganglia can’t properly filter the messages and it ends up sending the wrong signals to the thalamus. Whenever the thalamus receives a wrong signal, it becomes agitated and sends strong signals back to the prefrontal cortex. The prefrontal cortex reacts to these signals by increasing compulsive behavior and anxiety.

Another part of the neurobiological factor is the imbalance of the neurotransmitter serotonin in the brain. Serotonin helps to regulate mood naturally. It can also help with a couple of body functions like sleeping and digesting. Instead of crossing the synapse, serotonin is reabsorbed back into the nerve cells in the brains of people with OCD. Because of this, vital chemical messages are lost; OCD symptoms develop (Shafagh, 2016).

People that suffer from mental illnesses face stigma from the society. Researchers have found that due to stigma, people avoid seeking help from a health professional as they fear being labelled as ‘mentally ill’ by the society (Tai, 2016). The stigma we have in our country towards this issue is causing a negative impact on proper diagnosis and treatment. Obsessive Compulsive Disorder (OCD), in specific, goes undiagnosed most of the time. 9 in 10 people who suffer from this disorder do not seek any form of professional support (Tai, 2016).

Despite the fact that Singapore is known to be the OCD capital (Tai, 2016), people often stereotype OCD patients as very clean or neat people.

Many also think that OCD can be controlled and can be treated if the patients really wished to do so. What many do not know is that there is a wide spectrum in regards to the symptoms that are displayed by OCD patients. Generally, most of the symptoms are feeling the sense of fear, having recurring thoughts due to anxiety and repeating actions to relieve oneself from the anxiety that comes with the recurring thoughts (Morrison, 1995).